Category Archives: Bladder Expression/Urination

This time last year, Alec was one month out of surgery and had just returned for his first recheck exam with the neurologist. Based on his persistent lack of deep pain sensation, she told me (as any neurologist would have) that he “had a poor prognosis for return to normal function.” In other words, chances were slim that Alec would ever walk again.

At this point, we had moved into a vacant office on the first floor of ALDF headquarters in Sonoma County, Calif. Because Alec had come out of surgery for a herniated disc paralyzed, I could not take him home to our house in San Francisco, which had become inaccessible due to the stairs. We had nowhere to go. That’s how we ended up living in my office. I was sleeping on an air mattress next to Ali’s bed, eating microwave dinners, showering in the sink, and relying on my friends to take garbage bags full of laundry home every couple of days for me (Alec could not control his bladder or bowels and we went through towels, blankets, and sheets at mind boggling speeds). It seemed I did not leave his side for weeks, except to scurry to the bathroom.

I don’t think I registered the stress because there was no room for it. If you have ever been in a similarly stressful situation you will know what I mean. I proceeded hour by hour, minute by minute, doing the best I could with very little information, none of it especially good or encouraging. Alec had been hospitalized for two weeks, and I was terrified to bring him home and have the team of vet techs and doctors who were on hand 24/7 at the emergency facility shrink pathetically to just me, who had no idea what she was doing. Alec could not urinate by himself and I had to manually express his bladder several times a day (if done incorrectly, he would quickly develop an infection). I was shown how to do this at the vet hospital a few times and it was clearly difficult even for the professionals. This daunting task was made more difficult by his size. Although bladder expression is much easier when a dog is standing, Alec could not stand up and I was not strong enough to hold him up (at the vet hospital it took three vet techs to accomplish this task – once he was discharged there was only me) so I had to do it with him lying on his side, which is much harder. We went through box after box of piddle pads and diapers, because in between expressing his bladder, he would constantly dribble/leak and soil his bed. His bowels worked without my help but he had no control over them, so he would begin to poop and then try to get away from it but could only drag himself through it, smooshing it into his fur and his bed. I cleaned him and his bed up many times each day.

These first several weeks were difficult for both of us. But there were bright spots: my good fortune to work at an animal protection organization that allowed Ali and me to move into my office temporarily, a group of generous friends who supplied me with meals, laundry service, moral support, and donations of needed supplies, and an amazing local veterinarian who made “house calls” to my office to check on us every few days to make sure I was emptying Alec’s bladder completely and that he had not developed an infection. Oh, and the brightest spot of all – that Ali did not die, which I certainly thought he was going to during the harrowing days between his first and second surgeries (first surgery: 2/9/08; second surgery: 2/13/08). At this point, he was going downhill and nobody could figure out why. As his condition deteriorated, the neurologist speculated the spinal bruising might be moving up his spine (a fatal condition called “ascending myelomalacia”), which would have eventually paralyzed his vital organs, including his lungs. This was the first time she used the word “terminal” and I will never forget that feeling of falling.

As it turned out, the exact same disc that had been operated on mere days before had shattered again, for no apparent reason. Neither this neurologist nor anyone I have talked to since has heard of this happening before. It is a mystery, an apparently rare occurrence. This is why he had the second surgery. The neurologist told me she could operate again but warned me that it might not make any difference at all. and he could come out no better than before the surgery. It was a gamble. But we were out of options at that point so I said, yes, do it… do anything you can.

So Alec did not die and that was the best gift of all. But he was paralyzed. My playful, goofy, beloved shepherd who only a week before was running in the park playing his favorite game, “stick,” could no longer move his hind legs. However, I was told he could use a mobility cart (doggie wheelchair) to get around, even if he never walked again, and I was eager to do whatever it took to help Alec get his life back. Of course, I still hoped he would regain the ability to walk, but that hope became increasingly dim as the days passed and he still did not recover deep pain sensation, which brings us back to that first re-check in March 2008: my hope dissipated further when he was given that poor prognosis.

There is a lot more I could tell, both about those scary/crazy/stressful early days, and about how Alec began to slowly but steadily improve. I am going to skip over everything that has happened in the last year because much of our rehabilitation journey has been chronicled in this blog. I wanted to write this one-year anniversary post to emphasize how far Alec has come in the last 12 months. Because all you really need to know is that in early Feb. 2008 a disc suddenly shattered in Alec’s spine and he became paraplegic. He could not walk, could not control his bladder or bowels, and was expected to be paralyzed for the rest of his life. But he is walking now. Yes, walking…first with a lurch, now with a limp. Last month, he walked around the block without his wheels for the first time and we haven’t looked back. I am gradually increasing his time outside of his cart and he is doing great.

Let me just say it one more time, because it feels so damn good to write this: ALEC IS WALKING. Sometimes it’s hard for me to believe, just like it is hard for me to remember how I groped my way through those first few days and weeks without the panic swallowing me. Alec has defied all expectations. He is amazing. And hey, I am not going to sing my own praises here, but I did not give up on him either, which was also important. I gave him every chance and he took it, from one milestone to the next. Some people have wondered what his attitude was like when he came out of surgery paralyzed. I want to write more about this issue in another post, but I will tell you, Alec means the world to me, and I watched him closely for signs of depression. While there were of course changes and adjustments, Alec always had a good attitude. Honestly, his resilience and irrepressible spirit astonished me. His great attitude continues to this day, and has helped with his physical therapy and everything else we have been through on this road to recovery. Which by the way is not over…but I am happy to report that perhaps the biggest milestone of all has been reached. One year later, my boy is walking again.

I am happy to report that the move went very well! Except for the unfortunate accident I had involving a beer bottle, my wrist, and a lot of blood. No, I wasn’t drunk! I wasn’t even drinking. I swear. I was unloading my van, trying to get Ali’s big orthopedic bed out, when an errant 6-pack started tumbling toward the door (in that weird combination of slow and fast motion). A couple bottles hurtled past me to the ground and smashed in the gutter and in my panicked attempt to keep more from falling somehow I caused another one to crack open and the jagged pieces hit my wrist on the way down. What a mess…glass and beer everywhere (hi, new neighbors)! Once the blood started gushing and I saw where the three main cuts were (one was right in the suicide place, scarily near my vein, and the other was so deep it would more accurately be described as a “gash”), I started to get faint and called my roommate Maggie at work, just so someone would know where I was in case I passed out and bled to death, and she came immediately with our dusty ALDF first aid kit and bandaged me right up. She is awesome!! Why is this relevant to my Ali blog? Well, it was my right wrist and it was really painful (not to mention disgusting) for a couple days and I need both my hands and arms to deal with Ali without hurting us, so it was tricky. But a little over a week later I am completely healed and trying to be much more careful around glass. Although I think I may be accident prone.

To get to the raison d’être of this blog, Ali is doing really well and has settled nicely at our new place in Petaluma. He is using the ramp successfully and the park across the street is very convenient for us. I take him there 3 times a day (2 on work days) to exercise, go potty, and do ten minutes of standing exercises in his cart. He and Rita, Maggie’s dog, are getting along great and I couldn’t ask for a better canine roommate for him right now. She is pretty low key which is good, because he wanted to play immediately when he met her, and when Ali plays he throws his whole body into and even likes to spin around (his infamous “play spins”), so I had to watch him pretty carefully to make sure he did not overexert himself. It has been interesting adjusting to life outside of one room, because of course he sometimes wants to travel from room to room, or greet Maggie and Rita when they come home, and meet new people when they come over. I have to watch him so he does not drag himself, which he definitely was trying to do a lot at first (and still does sometimes) and when he wants to get up I run over and grab him by his Walkabout rear harness (aka his “shepherd handles”), which I leave on him all day until we go to bed, and assist him by lifting his rear legs so he can walk where he wants using his front. The rest of the time he is on one of his beds. Getting to and from work has been a challenge (obviously compared to the convenience of living in my office, ho, ho, ho). Everything takes so much longer, getting him in and out of the car is kind of tricky (and making sure he doesn’t get himself into some weird position while I am driving), but we are getting into the new routine. Last week we were able to join in our first staff dog walk since his surgery over two months ago, which was great. The other dogs were not quite sure what to make of his wheelchair at first, but it didn’t stop Alec from his favorite activity while walking with a group dogs – trying to pull to the head of the pack so he can be the first one in what must appear to onlookers like a dog parade.

I still need to keep his walks short and it’s better for his joints if he walks on grass (hence the park across the street being so convenient), but Juli, his rehab therapist, says eventually he can take long walks in the cart. For now though, she emphasizes that physical therapy is the most important thing I can do with him in the cart, more important than going on walks, and I need to keep doing his exercises throughout the day. She showed me a new exercise where I assist him to sit and then stand several times throughout the day for one minute. She came by last weekend to help with his cart problems and showed me a way to get him to urinate in the cart and it is working so I am very happy about that! Moreover, she believes she see some slight movement at the top of his back legs, where they meet the rest of his body (this is called “proximal motor”). She also believes he has deep pain perception (I pinched his tail once in front of her and she saw him react – the reaction I could not get for the neurologist during our initial re-check exam back in March). Since Juli believes Ali is showing some improvement, she suggested I make an appointment at Animal Care Center with the Dr. Tieber for another re-check. She said because she is not a doctor she can only “assess” Ali’s condition but not “diagnose” and thinks I should get a neurologist’s opinion on what she believes she is observing (i.e. some return of motor function).

After we see the neurologist, Dr. Tieber, we are going to have a rehab appointment with Juli and put Ali in the hydro-therapy tank for the first time. I really hope Dr. Tieber confirms what Juli is seeing. I feel like he is improving too – it seems like I can see his legs moving slightly sometimes in the cart – but I am afraid to get my hopes too far up. Our appointment is on Friday morning. Wish us luck!!!

Well, it looks like the “little problem” might be bigger than I thought. Leslie from Eddie’s Wheels unfortunately has been less than helpful. First she suggested I try “compressing” his bladder in the cart to get a stream flowing, since part of DM (degenerative myelopathy) is losing sphincter strength. I reminded her that Alec has IVDD, not DM, and explained that he has full bladder control and has not needed to be expressed in over a month. I also let her know that it’s basically impossible to express a dog who has control of his bladder muscles. I told her the only “accident” he had was the day after he got his cart because he was not able to urinate in it (despite the fact that I had no warning of this potentiality). And I said it was my understanding that dogs could urinate and defecate with no problem in these carts and that I would have considered different designs had I known this might be a problem. Finally, I let her know lifting his tail had worked a couple times, and not worked a couple times.

Her reply: “Most dogs can urinate with no problem in our carts, but a small percentage of males do have problems. I am sorry that your dog is one of them. Usually shifting the dog in the saddle solves the problem.”

Well, gee thanks! I only spent $500 on a cart that my poor dog, who has been through so danged much, can’t even urinate in (a serious problem given that a not-empty bladder virtually guarantees a urinary tract infection), which might be fine except for the fact that it says this on their website:

“Your pet can easily relieve itself and perform its normal bodily functions while in the cart.”

No mention of the “small percentage” of males who have problems, which of course would be helpful for customers to know before purchasing their cart, a rather expensive item. I can’t believe they would not even mention this “little problem” – a potential risk that the cart will pinch his urethra, thereby making it impossible for him to continue to urinate normally. And then act like it’s MY problem after they sell me the cart! Rrrrr. Yes, I am pissed off. Because Alec has had to deal with so much already and I really thought the people at this company actually cared about their clients’ companion animals. I guess once the sale is made, things change.

Luckily, Juli the rehab specialist is an angel and has been so helpful to us. She encouraged me not to return the cart – which they were only going to refund 2/3 the price of anyway…if I returned it in “new condition.” After paying shipping costs, I probably would have gotten $20 back. Not to mention no more walks for Alec until I ordered another cart and that we wouldn’t be able to move out of the office for several more weeks…ugh! Juli is convinced we can make it work and she even offered to come by tomorrow to see what she can do. We are so grateful for her. She is so much more helpful than the people who actually sold us the product. Thank you, Juli!! Tonight I shifted him around some and he was able to get a stream going, so maybe I will be able to fix this problem on my own. I hope so. No thanks to you, Eddie’s Wheels! I really hope they add a disclaimer to their website so other people will be aware of this potential problem before they put their dog in it.

Photo: A much happier moment right after the cart arrived, before I knew the thing would squish his urethra! Ali is enjoying a flying saucer filled with peanut butter, which successfully distracted him while we put him in the strange new contraption for the first time.

Some things just sound better in French, n’est-ce pas? Anyway, after my exuberant post of last night, I realized we had a potentially serious problem. Alec had not been urinating well in the cart, and I thought he just “needed time” to adjust. Well, that was a bad call, as I noticed he had peed all over his bed, literally right after I posted about how great everything was with the cart. He has not had an “accident” in his bed in over a month, ever since he started going to the bathroom outside… I even took the wee wee pads off his bed last week (is the universe smiting me for letting my guard down?). So it was a giant mess and all over him too. I could tell he felt really bad, he didn’t want to go in his bed; his bladder was just full. And of course he was reacting to my distress. I didn’t get angry but I did almost start crying – it was just such a mess and I felt so bad! Not to mention confused. Why is he not going? He pooped fine so it’s not some psychological “I don’t want to go in this weird contraption” type thing. And I noticed he was going over to his usual spot and lifting his tail (which I have come to recognize as the bladder pump), but nothing was coming out. Juli said she never had a problem with a dog not urinating in the cart (of course!) and that maybe it needed adjusting. She suggested I call Leslie at Eddie’s Wheels for their advice. So I emailed Leslie photos today of Ali in the cart and she said it did look like a perfect fit, which I was happy to hear. But that means nothing to adjust in order to fix the problem. She said they “occasionally hear of male dogs who cannot urinate while in the cart. We suspect that their urethras are being pinched off by the way they fit in the saddle. The usual solution is for you to gently lift the dog’s rump – using the tail is ok -and see if he can urinate when you elevate his rump a little bit.” So I tried that this evening and the first time it didn’t work, but the next time it did… althought I don’t know if he was able to empty. I will keep trying. If this doesn’t work, I don’t think anyone has other suggestions… and he just has to be able to urinate in his cart.

The better news is that he is loving his wheels and enjoying his short walks outside. If only we can solve this little problem…

I placed the order for Alec’s cart from Eddie’s Wheels (http://www.eddieswheels.com/) but now we have to wait 3 weeks for it to arrive. They take 2 weeks to build and a week to ship from Mass. to Calif. It is definitely a relief to finally have the order in. The measurements for these carts have to be exact and they are not the easiest to obtain. Juli, the rehabilitation specialist, and I measured him on two separate occasions (with another set of measurements done by myself and two friends for good measure) before we were comfortable that we had the precise numbers. We had some trouble getting accurate measurements across the top of his back, which is a part of the cart that is welded and definitely cannot be adjusted after the fact. If the cart does not fit right it has to be sent back and another cart built, meaning another 3 weeks and you have to pay for the new cart. So I really hope it fits him when it arrives!! My credit card has not been charged yet, but I think it is going to cost around $600.

And Alec is still going to the bathroom outside a lot so I haven’t really been expressing his bladder. I tried once early this morning but did not try for the rest of the day – I just let him go outside on his own. To see how well he was emptying (or not), I asked Dr. Leavey to stop by on her way home this evening to check his bladder with a catheter and she extracted four tablespoons of urine, which is not very much. So signs seem good that he is mostly emptying on his own, which is amazing! Fingers crossed that this continues.

Since I have to leave my house (and fabulous housemates Courtney, Nicte, and Javier [and Courtney’s dog Usha, who was Alec’s best friend]) in San Francisco, I have been looking for a new place with my friend and co-worker, Maggie, who also found herself needing to move recently. We had not had much luck until we found a really gorgeous place in Petaluma, the bottom floor of an old Victorian house just about 15 minutes from work and in a nice neighborhood with two parks close by (also right across the street from a really good Thai restaurant, where we will never be able to afford to eat!). We had looked at some less expensive, but sketchier, neighborhoods in Santa Rosa and while I would not have minded these types of transitional neighborhoods “before,” when Alec was mobile, I would just not feel comfortable walking around a bad neighborhood with a disabled dog in a cart. Ali has been more protective of me than ever since his injury – I’m sure it’s because he cannot get up and check things out so he is trying to preemptively deter everyone through rather indiscriminate barking. Well, it seems indiscriminate to me, but in his mind I’m sure it serves a purpose! So, the anxiety it would cost me to live in the more gang-friendly neighborhoods is not worth the few dollars of rent it would save. Plus, I really did not want to move further north if I could help it. Petaluma is to the south of the ALDF office and closer to San Francisco, so this makes me happy as I am planning to go back and visit my old roommates a lot once Ali is good to go with his new wheels.

It all sounds good, right? Yes, but the place, although it is on the first floor, has 6 steps leading up to the porch. I didn’t think it would work because of this fact, but my good friend Steve said he could and would be willing to build a ramp if the landlord would be okay with that. I then checked with his rehab specialist and she said a ramp would be fine once he gets his cart. So, we went ahead and signed the lease tonight because everything else about the place seemed really great (well, obviously except for the fact that it’s not in San Francisco, but there is nothing I can do about that right now so am trying not to dwell!) – but now I am really worried. What if the ramp situation doesn’t work out? Did I just make a huge mistake?? I have had to make so many big decisions lately about me and Ali and our future and his well-being; it can be overwhelming at times. Hard to think we were cruising along enjoying a relatively uncomplicated life just 6 weeks earlier…

I stopped the Phenoxybenzamine completely today. I have been expressing him less but he has been going to the bathroom a lot on his own, so things seems to be going well in that area – for now.